The Underestimated Consequences of Uncontrolled Gout: Renal and Cardiovascular Implications

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Dr. Johnson:
This is CME on ReachMD. I’m Dr. Richard Johnson, and today we’re going to talk about Gout: Beyond the Joints. What’s the hidden danger?

So gout is common. It affects 9 million people in the United States. It is caused by a high uric acid in the blood that then can increase the risk for it to precipitate and form crystals in the joints. It is driven in part by diet. It’s driven in part by genetics. But a very, very important cause is kidney function, and that’s because the kidney has a major role in excreting uric acid.

Now, not only does areduction in kidney function raise uric acid, but diseases that are associated with a reduction in kidney function, such as diabetes and hypertension, are also associated with a high uric acid. So it’s like a two-way street in which diseases that are associated with a high uric acid lead to kidney disease, and kidney disease, in fact, also leads to a high uric acid. So this is why the kidneys are so important in gout. And, in fact, in people who have normal kidney function, only about 1 in 50 people have gout, but in people who have reduced kidney function, almost a quarter of the people have gout. And likewise, the high uric acid is seen in about 15% of the adult population who have normal kidney function, but in the vast majority of patients who have reduced kidney function.

So kidney disease is part and parcel of having gout, and more than 50% have kidney disease who have gout.

So what is the hidden danger? Well, we talk about gout as being simply an arthritis, you know, a very painful disease involving the joints, like the big toe and the ankle and the wrist. But in fact, gout is a systemic disease. The crystals are not just depositing in the joints; they’re in the other the tissues as well. Now we know that there are crystals that are forming, of course, in the skin and in the kidneys and in other sites.

And so the crystals are associated with inflammation, and systemic inflammation is associated with a lot of problems. And so when you get a gout attack, you’re getting fever and inflammation, but even when the gout subsides, that inflammation persists. And so it’s so important that we try to control gout to control the inflammation, as the inflammation has been associated with a lot of complications, like heart disease, and diabetes, and kidney disease, and so it’s all part of one big complex, one big syndrome. And we should view gout as not just an arthritis but as a systemic disease that warrants treatment to help not just the joint pain but other aspects of the systemic symptoms.

So with that is my little bite-sized talk for you, and that’s our time. Thanks for listening.

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